Pediatric Coding Alert

When a pediatrician admits a patient to observation status, keeping the numerous E/M codes straight requires more than a watchful eye. Consider the following scenarios to avoid incorrectly reporting the physician's services, which could result in undercharging or even double-dipping. 1. Same-Day Admission and Discharge Before CPT created same-day admission and discharge observation care service codes (99234-99236) in 1998, physicians had no way of charging for such services. "Carriers will pay for only one E/M service per day," says Charles A. Scott, MD, FAAP, pediatrician at Medford Pediatric and Adolescent Medicine in Medford, N.J. In fact, CPT Codes does not actually state that you can report only one E/M per day. Conventional wisdom and reimbursement experience, however, dictate that insurers will not pay for more than one encounter on the same day. So, carriers would pay for the admission service only and not the discharge service.

Now, instead of using the initial observation care codes (99218-99220) in conjunction with a separate discharge code (99217), physicians have the same-day admission and discharge codes (99234-99236) as an option. These codes have more relative value units (RVUs) than the initial observation care codes (99218-99220), but fewer RVUs than a two-day observation, consisting of an initial observation care code (99218-99220) and a discharge code (99217). Although CPT does not require a minimum length of stay when reporting 99234-99236, Medicare has a minimum time requirement. For all non-Medicare payers, when a physician admits a patient to observation care and discharges the same day, you should report same-day admission and discharge codes 99234-99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date ), says Dee Mandley, RHIT, CCS, CCS-P, director of HIS and education services for CURES, a coding and compliance company in Twinsburg, Ohio. You should report 99234-99236, regardless of the length of stay, as long as documentation reflects that the pediatrician performed both an admission and a discharge. For instance, an emergency department physician calls a pediatrician at home at 2 a.m. regarding a girl who has croup (464.4). The pediatrician admits the patient to observation over the phone. He visits the patient on rounds at 8 a.m. and discharges her. You should bill a same-day admission and discharge from observation (99234-99236), Scott says. The pediatrician performed two services. He first admits the patient to observation care and subsequently discharges her. Select the appropriate-level same-day admission and discharge observation code based on the complexity of medical decision-making, examination and history documented. These codes, unlike other E/M codes (outpatient services, hospital care, etc.), are not time-based. Link 9923x to 464.4. You should not report discharge code 99217 because it [...]